Abstract B18: Race and trust as predictors of willingness to recommend HPV vaccination

Abstract

Abstract Racial disparities in cervical cancer incidence and mortality persist, with incidence rates highest among Latinas and mortality rates highest among Black women compared to other racial/ethnic groups. Routine vaccination against high-risk human papilloma virus (HPV) types that are causally associated with cervical cancer is recommended for females aged 11–12, with use by females as young as 9 years. Studies indicate a broad range in rates of vaccine acceptability among parents and caregivers but little attention has been paid to sociocultural factors that influence acceptability across racial groups. One such factor that may play a central role in vaccine acceptability is healthcare-related trust, a variable that often differs across racial groups and is typically lower in communities of color compared to whites. Therefore, the goal of the current study was to examine the association between race, healthcare-related trust, and willingness to recommend the HPV vaccine to younger female relatives in a diverse urban sample of adult women. Participants were 2147 women age 27 and older (mean age=49 years) recruited through a quota sampling strategy in Queens, NY as part of a larger intervention study. All participants completed street intercept interviews that asked about basic sociodemographic and healthcare information, one's prior awareness of the HPV vaccine, and whether one would recommend the vaccine to a daughter or other family members. Participants were also asked the extent to which they trusted doctors and hospitals. Approximately 60% of the sample self-identified as African American or Latino and the remainder as White or Asian. Seventy-six percent reported that they had heard of the HPV vaccine previously. Multivariable logistic regression that included only sociodemographic and healthcare variables revealed that, compared to Latinas, Black (OR=.522, 95% CI: .400 − .683, p<.0001), Asian (OR=.644, 95% CI: .476 − .873, p<.005), and White women (OR=.521, 95% CI: .394 − .687, p<.0001) were less likely to be willing to recommend HPV vaccination, in addition to those with no awareness of the HPV vaccine before the interview (OR=.656, 95% CI: .528 − .815, p<.0001). Women of higher education levels (OR=1.233, 95% CI: 1.018 − 1.492, p<.03) and those adherent to pap test guidelines (OR=.594, 95% CI: .472 − .746, p<.0001) were more likely to be willing to recommend. The next set of analyses examined the effect of trust on willingness to recommend the vaccine across racial groups, in addition to the other sociodemographic and healthcare variables. Trust emerged as a significant independent predictor of willingness to recommend for Latinas (OR=1.312, 95% CI: 1.037 − 1.660, p<.02), Black (OR=1.838, 95% CI: 1.462 − 2.310, p<.003), and Asian (OR=1.651, 95% CI: 1.192 − 2.287, p<.003) women but not for White women (OR=1.257, 95% CI: .979 − 1.612, p<.07). Results suggest that Latina and Black women who report low trust in providers and healthcare settings are an important focus for interventions related to increasing knowledge and uptake of HPV vaccination. Future work may also further explore other factors in addition to trust that account for greater willingness to recommend vaccination among Latinas and investigate their relevance, strength, and mutability in other racial groups. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B18.